| The following vignette applies to the next 2 items. |
Item 1 of 2
A 22-year-old woman comes to the clinic for a routine examination. The patient is well and has no concerns. She is a gymnast, and her main activity is the balance beam. Three months ago, she sustained a vulvar contusion during a competition but otherwise she has been healthy. The patient is sexually active with 2 male partners and uses an intrauterine device for contraception. She does not use tobacco, alcohol, or illicit drugs. Examination shows a mobile, soft, nontender, flesh-colored, 2-cm cystic mass at the 4 o'clock position at the base of the left labium majus. Which of the following is the most likely diagnosis for this patient?
Show Explanatory Sources
This patient has an asymptomatic Bartholin duct cyst. The Bartholin glands are located bilaterally at the posterior vaginal introitus and have ducts that drain into the vulvar vestibule at the 4 and 8 o'clock positions to provide vulvovaginal lubrication. The Bartholin ducts may become obstructed either from accumulation of mucus or secondary to edema and trauma, though many cases are idiopathic. The resultant obstruction causes proximal duct distension, resulting in cyst formation. This soft, mobile, nontender cystic mass can be asymptomatic and may be found incidentally at the base of the labia majora. With sufficient enlargement, it may cause discomfort during walking, sitting, and sexual intercourse.
(Choice B) Condylomata acuminata result from human papillomavirus infection, particularly types 6 and 11. Growths may be exophytic or sessile, and either solitary or multiple, but condylomata do not form cystic masses.
(Choice C) A Gartner duct cyst results from incomplete regression of the Wolffian duct during fetal development. These cysts appear along the lateral aspects of the upper anterior vagina. In contrast to Bartholin gland cysts, they do not involve the vulva.
(Choice D) A vulvar hematoma typically results from local trauma and presents as a tender, ecchymotic, firm mass.
(Choice E) Molluscum contagiosum presents as small, firm, painless bumps with central umbilication. Although mostly asymptomatic, it may cause localized itching.
(Choice F) Primary syphilis presents with a chancre (ie, a painless ulcer with a raised edge), not a cystic mass.
(Choice G) Skene glands are bilateral paraurethral glands in the anterior vaginal vestibule. Skene gland cysts may form with duct obstruction but would be located lateral to the urethral meatus.
Educational objective:
Bartholin duct cysts are soft, mobile, nontender masses at the base of the labia majora at the 4 and 8 o'clock positions. These cysts can be asymptomatic and found incidentally on examination.